3
1 Federal State Budgetary Educational Institution of Further Professional Education RMANPE of the Ministry of Health of Russia, Moscow, Russia
2 Association of Pediatricians, Moscow, Russia
3 Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuing Professional Education” of the Ministry of Health of the Russian Federation, Moscow; GBUZ "Children's City Clinical Hospital named after. BEHIND. Bashlyaeva" DZ Moscow

For quotation: Zakharova I.N., Tvorogova T.M., Zaplatnikov Fever in children: from symptom to diagnosis // Breast cancer. 2013. No. 2. P. 51

The diagnostic search for the cause of fever is the most significant in the work of a pediatrician; it requires professional skill and an individual approach in each specific case. Hyperthermia can be a manifestation of many diseases and pathological conditions - from impaired thermoregulation as a result of infectious, somatic, hematological diseases to mental and autonomic disorders. In most cases, the pediatrician must independently figure out the cause of the fever and make the correct diagnosis. In these cases, the doctor is helped by knowledge of the mechanisms of thermoregulation disturbances during hyperthermia, the main variants of the course of fever, and the clinical symptoms of diseases that manifest themselves with an increase in temperature and occur against its background.

It is known that in the process of evolution, a typical thermoregulatory protective-adaptive reaction in response to the influence of various pathogenic stimuli was developed and genetically consolidated. This reaction is manifested by a restructuring of temperature homeostasis, aimed at increasing body temperature to increase the natural reactivity of the body. An increase in body temperature in response to exposure to various pathogenic irritants (pyrogens) is usually referred to as fever.
Increased natural reactivity of the body, observed during fever, includes increased phagocytosis activity, increased interferon synthesis, accelerated transformation of lymphocytes, stimulation of antibody formation, inhibition of viruses and bacteria.
Fever is fundamentally different from the normal response to excessive production or loss of heat by the body. This is due to the fact that when the body temperature increases (muscular work, overheating, etc.), the thermoregulation center remains set to normalize the temperature. While during fever, thermoregulation purposefully “rearranges” the processes of heat production and heat transfer to change temperature homeostasis in the direction of increasing body temperature. The mechanism of fever development is presented in Figure 1.
Based on the currently available data, it is incorrect to say that there is a synthesis of a single substance that causes fever; it is more correct to assume the presence of a cascade of immune-mediated reactions, as a result of which substances that stimulate the hypothalamus are formed. Activated macrophages secrete more than 100 biologically active substances, among which the main mediator of fever is the proinflammatory cytokine interleukin-1. Penetrating the blood-brain barrier under conditions of impaired immune homeostasis, interleukin-1 affects the receptors of the thermoregulation center, which ultimately leads to a restructuring of thermoregulation and the development of fever.
Since fever is a nonspecific protective-adaptive reaction of the body, the reasons that cause it can be very diverse. There are infectious and non-infectious fever. Any infections, as well as vaccines, can cause fever due to the entry or formation of pyrogens in the body.
Exogenous pyrogens are: endotoxin of gram-negative bacteria, endotoxins of diphtheria bacilli and streptococci, protein substances of dysentery and paratyphoid bacilli. At the same time, viruses, rickettsia, spirochetes do not have their own endotoxins, but cause fever by stimulating the synthesis of endogenous pyrogens by the cells of the macroorganism itself.
Fever of a non-infectious nature is more diverse from an etiological point of view and can be caused by one of the following causative factors:
. immune (diffuse connective tissue diseases, vasculitis, allergic diseases);
. central (damage to various parts of the central nervous system - hemorrhage, tumor, trauma, cerebral edema, developmental defects);
. psychogenic (functional disorders of higher nervous activity (neurosis, mental disorders, emotional stress));
. reflex (pain syndrome due to urolithiasis, cholelithiasis, peritoneal irritation, etc.);
. endocrine (hyperthyroidism, pheochromocytoma);
. resorption (bruise, compression, incision, burn, necrosis, aseptic inflammation, hemolysis contribute to the formation of endogenous protein pyrogens - nucleic acids);
. medicinal (enteral or parenteral administration of xanthine drugs, hyperosmolar solutions, antibiotics, diphenin, sulfonamides);
. hereditary (familial Mediterranean fever - periodic disease);
. lymphoproliferative process (lymphogranulomatosis, non-Hodgkin's lymphoma);
. granulomatous disease (sarcoidosis, etc.);
. metabolic diseases (hyperlipidemia type I, Fabry disease, etc.).
Each of these causative factors of fever, despite the general mechanisms of thermoregulation disturbance, has specific features of pathogenesis and clinical picture. The temperature reaction of non-infectious origin is associated with the central and peripheral action of endogenous pyrogens, hormones and mediators, while the main link in the pathogenesis of fever is a decrease in heat transfer without an increase in heat production.
Fever is usually assessed by the degree of increase in body temperature, the duration of the febrile period and the nature of the temperature curve.
Depending on the degree of temperature increase, the fever can be: low-grade (37.20°-38.00°C); low febrile (38.10°-39.00°C); high febrile (39.10°-40.10°C); excessive (hyperthermic) - over 41.10°C.
Depending on the duration of the febrile period, ephemeral fever is distinguished (from several hours to 1-3 days); acute (up to 15 days); subacute (up to 45 days); chronic (more than 45 days).
It should be noted that at present, in practical work, classical temperature curves that make it possible to identify the nature of fever (constant, laxative, intermittent, debilitating, irregular) are rarely seen due to the widespread use of antibacterial and antipyretic drugs at the onset of the disease.
Particular attention should be paid to the clinical equivalents of compliance/inconsistency of the processes of heat transfer and heat production, because Depending on individual characteristics and background conditions, fever, even with the same level of hyperthermia, can occur differently in children.
There are “pink” and “pale” variants of fever. If, with an increase in body temperature, heat transfer corresponds to heat production, then this indicates an adequate course of fever. Clinically, this is manifested by “pink” fever. In this case, normal behavior and satisfactory well-being of the child are observed, the skin is pink or moderately hyperemic, moist and warm to the touch. This is a prognostically favorable variant of fever. The absence of sweating in a child with fever and pink skin should raise suspicion of severe dehydration (vomiting, diarrhea, tachypnea).
In the “pale” version, heat transfer does not correspond to heat production due to a significant impairment of peripheral circulation. In this case, a disturbance in the condition and well-being of the child, chills, pallor, marbling, dry skin, acrocyanosis, cold feet and palms, and tachycardia are clinically noted. These clinical manifestations indicate a prognostically unfavorable course of fever.
One of the clinical variants of the unfavorable course of fever is hyperthermic syndrome. This is a pathological variant of fever, in which there is an inadequate restructuring of thermoregulation with a sharp increase in heat production and a sharp decrease in heat transfer. Clinically, this is a rapid increase in body temperature, impaired microcirculation, metabolic disorders and progressively increasing dysfunction of vital organs and systems, as well as the lack of effect from antipyretic drugs. It should be remembered that the basis for distinguishing hyperthermic syndrome into a separate variant of the temperature reaction is not the degree of increase in body temperature to specific numbers, but the severity of the condition, which ultimately determines the prognosis of the disease.
In young children, the development of hyperthermic syndrome in the vast majority of cases is caused by infectious inflammation with the development of toxicosis. Hyperthermic syndrome and “pale” fever, in contrast to “favorable” and “pink” fever, are a direct indication of the need for comprehensive emergency care.
Thus, with the same level of hyperthermia, different variants of the course of fever can be observed, the development of which is directly dependent on the individual, age, premorbid characteristics and concomitant diseases of the child.
Fever can cause the development of severe pathological conditions. Possible complications in febrile conditions are given in Table 1.
It is known that increased body temperature is a nonspecific symptom that occurs in numerous diseases and pathological conditions.
When carrying out differential diagnosis, you should pay attention to the clinical picture of fever, which will narrow the range of possible causes of fever. This applies to the presence of chills, sweating, intoxication syndrome, and lymphadenopathy. Thus, chills and severe sweating are characteristic primarily of a bacterial infection, but can also be observed during the lymphoproliferative process (lymphogranulomatosis). Intoxication due to infectious pathology is expressed by severe weakness, absence or significant decrease in appetite, nausea, vomiting, dry mucous membranes, and oliguria. Fever of a viral nature is often accompanied by lymphadenopathy, while the lymph nodes are soft, limited from the surrounding tissues, symmetrical, and slightly painful.
Important elements of differential diagnosis are:
. pathognomonic clinical symptoms and symptom complexes that allow diagnosing the disease;
. results of paraclinical studies.
Mandatory methods of primary examination of a patient with fever include: thermometry at 3-5 points (in the armpits, groin areas, in the rectum); biochemical blood test (CRP, fibrinogen, protein fractions, cholesterol, liver enzyme activity, etc.); general urine analysis. Additional studies in a child with fever are carried out depending on the complaints and symptoms identified during dynamic observation.
The clinical picture of the disease in combination with the indicated laboratory parameters allows us to differentiate between “inflammatory” and “non-inflammatory” fever. Signs of an “inflammatory” fever include:
. connection between the onset of the disease and infection (catarrhal symptoms of the upper respiratory tract, the presence of symptoms of an infectious disease, aggravated epidemiological history);
. inflammatory changes in the blood (leukocytosis, acceleration of ESR, increased levels of fibrinogen, C-reactive protein, dysproteinemia);
. presence of symptoms of intoxication;
. disturbance of well-being;
. tachycardia and tachypnea;
. relief of fever with the use of antipyretics;
. positive effect when prescribing antibacterial agents.
Fever in immunopathological processes is persistent and has a number of features, most pronounced in the allergic variant of juvenile rheumatoid arthritis:
. by nature - intermittent, by severity - febrile with one or two daily peaks;
. an increase in temperature is accompanied by skin rashes;
. the appearance of fever is observed long before the development of articular syndrome, lymphadenopathy and other manifestations of the disease;
. when antibacterial therapy is prescribed, the fever does not decrease;
. antipyretics give a weak and short-term effect;
. the administration of glucocorticosteroid drugs leads to normalization of temperature within 24-36 hours;
. in a clinical blood test: leukocytosis with a neutrophilic shift, acceleration of ESR to 40-60 mm/h; CRP - sharply increased.
A “non-inflammatory” temperature reaction is characterized by: good tolerance of fever; presence of connection with psycho-emotional influences; absence of chills, possible feeling of heat; normalization of temperature at night; lack of adequate increase in heart rate when the temperature rises; spontaneous decrease in temperature; lack of effect from antipyretic drugs; detection of asymmetry during temperature mapping (temperature measurement at 5 points).
Autonomic disorders accompanied by fever are most common in children of preschool and school age, especially during puberty. It is noted that periods of increased temperature are seasonal (usually autumn, winter) and can persist for several weeks.
It should be emphasized that fever is regarded as a consequence of neurovegetative dysregulation only when the child is examined and other possible causes of hyperthermia are excluded. In this case, complex treatment of vegetative dystonia is carried out, and antipyretic drugs are not prescribed.
In case of fever caused by endocrine pathology, accompanied by increased formation of hormones (thyroxine, catecholamines), drug allergies, the use of antipyretics is also not required. The temperature usually normalizes when the underlying disease is treated or when the allergenic drug is discontinued.
Fever in newborns and children of the first 3 months. requires close medical supervision. Thus, if a fever occurs in a newborn baby during the first week of life, it is necessary to exclude the possibility of dehydration as a result of excessive weight loss, which is more common in children born with a large birth weight. In these cases, rehydration is indicated. In newborns and children in the first months of life, there may be an increase in temperature due to overheating and excessive excitement. Similar situations often occur in premature infants and children born with signs of morphofunctional immaturity. At the same time, the air bath helps to quickly normalize body temperature. If fever persists in children under 3 months. life, hospitalization is indicated to exclude pathology and the possibility of developing complications of a febrile state.
Differential diagnosis of fever usually leads to clarification of its cause and establishment of a diagnosis. In some cases, the cause of fever remains unclear, and then hyperthermia is interpreted as fever of unknown origin (FOU). LNG is spoken of when the fever lasts more than 2-3 weeks, the temperature rises above 38.00°-38.30°C, and if the diagnosis is not established within a week of intensive examination. However, even in the case of unclear fever, what is subsequently diagnosed is not unusual pathological processes, but diseases well known to doctors, which occur atypically and manifest themselves in the onset predominantly as a febrile syndrome. According to the literature, in 90% of cases the causes of LNG are serious infections, diffuse connective tissue diseases, and cancer.
When determining the cause of LNG, the pediatrician should:
1. Rule out the presence and exacerbation of foci of chronic infection in the nasopharynx (sinusitis, tonsillitis, adenoiditis).
2. Clarify the tuberculosis history, because it should be remembered that one of the most common causes of LNG is tuberculosis. Prolonged fever may indicate the appearance of extrapulmonary foci of the disease. The most common extrapulmonary sites of infection are the kidneys and bone tissue.
3. It is necessary to remember about the possibility of developing endocarditis in children with congenital heart defects.
4. The onset of one of the variants of systemic vasculitis (Kawasaki disease, polyarteritis nodosa) should be excluded, because the latter account for about 10% of all cases of LNG.
5. It is important to know that fever can be one of the manifestations of an allergic reaction to various medications, incl. and antibacterial.
6. Among malignant neoplasms, lymphomas are most often accompanied by fever.
Along with clinical and traditional paraclinical data, additional studies are required to identify the possible cause of LNG.
Table 2 presents informative research methods, which, together with clinical symptoms, will allow the doctor to competently and purposefully conduct a diagnostic search and identify the cause of fever, previously regarded as LNG. When compiling the table, we used many years of clinical observations and experience of employees of the Department of Pediatrics of the Russian Medical Academy of Postgraduate Education, literature data, as well as the Nomenclature of Works and Services in Healthcare of the Russian Federation.
In pediatric practice, fever is one of the main reasons for the uncontrolled use of various medications. At the same time, medications, including antipyretics, are often prescribed without good reason. Obviously, in case of fever, it is advisable to strictly adhere to a certain algorithm of actions.
First of all, it is necessary to determine whether a child with a fever needs emergency care and to find out whether the child's fever is a risk factor for developing serious complications. Children at risk for developing complications from fever include:
. up to 2 months at temperatures above 38°C;
. up to 2 years at temperatures above 39°C;
. at any age at temperatures above 40°C;
. with a history of febrile seizures;
. with diseases of the central nervous system;
. with chronic pathology of the circulatory system;
. with obstructive syndrome;
. with hereditary metabolic diseases.
Depending on the analysis of clinical and anamnestic data, an individual observation strategy and rational tactics of therapeutic actions are selected in each specific case. Algorithms of therapeutic measures depending on the presence of premorbid background and the severity of hyperthermia are shown in Figures 2 and 3.
It is known that if in a child with an uncomplicated premorbid background the temperature reaction is favorable (“pink” fever), does not exceed 39 ° C and does not have a negative effect on the child’s condition, then one should refrain from prescribing antipyretics. In these cases, drinking plenty of fluids is indicated, and physical cooling methods can be used.
In situations where clinical and anamnestic data indicate the need for antipyretic therapy (children at risk, pale fever, hyperthermic syndrome), one should be guided by the official recommendations of the WHO, Federal guidelines, recommendations of the Union of Pediatricians of Russia on the strategy for using antipyretics in children. Among all antipyretic drugs, only paracetamol and ibuprofen are recommended for use in pediatric practice, since they fully meet the criteria of high therapeutic efficacy and safety.
According to WHO recommendations, acetylsalicylic acid should not be used as an analgesic-antipyretic in children under 12 years of age due to the risk of a serious complication - the development of Reye's syndrome. The use of metamizole as an antipyretic and analgesic is permissible only in case of individual intolerance to the drugs of choice (paracetamol, ibuprofen) and the need for parenteral use of an antipyretic.
The mechanism of action of ibuprofen and paracetamol has been studied and widely covered in the literature. The antipyretic effect of the drugs is based on the inhibition of prostaglandin synthesis by reducing the activity of cyclooxygenase (COX). It is known that COX and its isoenzymes are directly involved in the synthesis of prostaglandins. By blocking the activity of COX and reducing the synthesis of pro-inflammatory prostaglandins, drugs have antipyretic, analgesic and anti-inflammatory effects.
Ibuprofen has a dual antipyretic effect - central and peripheral. The central effect is to block COX in the central nervous system and, accordingly, suppress pain centers and thermoregulation. The mechanism of the peripheral antipyretic effect of ibuprofen is due to the inhibition of the formation of prostaglandins in various tissues, which leads to a decrease in the phagocytic production of cytokines, including the endogenous pyrogen - IL-1, and to a decrease in inflammatory activity with normalization of body temperature.
The antipyretic and analgesic effects of paracetamol are associated with inhibition of COX activity in the central nervous system without affecting the enzyme localized in other tissues. This explains the weak anti-inflammatory effect of the drug. At the same time, the absence of a blocking effect on COX and the synthesis of prostaglandins in tissues determines the absence of a negative effect of the drug on the mucous membranes of the gastrointestinal tract and water-salt metabolism.
When carrying out antipyretic therapy, paracetamol and ibuprofen can be used as monotherapy from 3 months. life, and their combination - from 3 years. Studies have shown that the effectiveness of ibuprofen and paracetamol when used together is higher than each of them separately, i.e. drugs in combination mutually enhance their effect. The potentiating effect of the drugs has been confirmed in clinical studies. It was noted that a decrease in temperature due to the combined use of paracetamol and ibuprofen is achieved at lower doses than from these drugs used separately.
Contraindications to the use of paracetamol are diseases of the liver, kidneys and hematopoietic organs, as well as deficiency of the enzyme glucose-6-phosphate dehydrogenase, contraindications to the use of ibuprofen - erosive and ulcerative lesions of the gastrointestinal tract during an exacerbation and pathology of the optic nerve.
It should be noted that the simultaneous prescription of 2 antipyretic drugs significantly reduces the compliance of patients and their parents to treatment. The accuracy of dosing of recommended drugs is often difficult. Moreover, the possibility of irrational combinations increases the risk of adverse reactions. In this regard, a fixed combination of antipyretics is preferable.
The only fixed low-dose combination of two antipyretics registered in Russia for use in pediatric practice is the drug Ibuklin. Ibuclin contains ibuprofen and paracetamol. The drug has significant advantages over each of its components, because this combination combines safety with the rapid onset of action of the drug and the duration of the antipyretic effect.
Dispersed tablet of children's dosage form (Ibuklin Junior) contains 125 mg of paracetamol and 100 mg of ibuprofen. The tablet is dissolved in 5 ml of water to obtain a suspension using the included spoon. Single dose - 1 tablet. The daily dose depends on the age and weight of the child:
. 3-6 years (15-20 kg) - 3 tablets per day;
. 6-12 years (20-40 kg) - 5-6 tablets per day. with an interval of 4 hours;
. children over 12 years old - 1 “adult” tablet 3 times a day. It should be remembered that Ibuklin should not be taken by patients of any age for more than 3 days as an antipyretic.
It should be remembered that the possible causes of fever are extremely diverse, therefore only a thorough history taking, analysis of clinical data in combination with an in-depth targeted examination will allow the attending physician to identify the specific cause of fever, diagnose the disease and prescribe appropriate therapy.

Literature
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2. Saper C.B., Breder C.D. Endogenous pyrogens in the CNS: role in the febrile respons // Prog. Brain Res. 1992. 93. P. 419-428.
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5. Cheburkin A.V. Pathogenetic therapy and prevention of acute infectious toxicosis in children. - M., 1997. - 48 p.
6. Fundamentals of perinatology / Ed. N.P. Shabalova, Yu.V. Tsveleva. - M: MEDpress-inform, 2002. - P. 393-532.
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It seemed that just an hour ago the little one was cheerful, inquisitive and sparkling with cheerfulness. But then the eyes sparkled, the cheeks turned red, and the laughter gave way to crying and whims. With a familiar gesture, mommy reaches out to touch her forehead, after which she immediately runs for a thermometer. That’s right: the baby has a fever. Sound familiar? And as often happens, family members are tormented by thoughts: what caused such changes in mood and behavior and is it worth lowering the temperature that has arisen for no apparent reason?

Symptoms of fever in children

In terms of its frequency, fever in children (nothing more than fever or fever) occupies almost the first place among the symptoms of various diseases. An increase in body temperature is a reaction to the action of all kinds of pathogenic factors (bacteria, viruses, their decay products), and it is not advisable to bring it down to a certain extent - the unreasonable and unjustified use of antipyretics can negatively affect the body's resistance.

There are several types of fever in children. So, depending on how high the body temperature is, fever is divided into:

• Low-grade fever, when the thermometer shows 37-38 °C;
• Febrile (moderate – 38-39 and high – 39-41 °C);
• Hyperpyretic if temperatures exceed 41 °C.

In addition, the febrile state is divided by duration:

• Ephemeral (usually the temperature returns to normal after a few hours or days);
• Acute (fever lasts up to two weeks);
• Subacute (the baby can be sick for about a month and a half);
• Chronic (cannot cope with the disease for more than six weeks).

According to clinical manifestations, fever in children is divided into pink and white (pale). The first option is more favorable, since in this state the amount of heat given off by the body is approximately equal to its production. The baby's skin is pink (hence the name) and warm, and his overall health is quite satisfactory.

With white fever, the symptoms in children are more pronounced and noticeably more severe. The baby exhibits behavioral disorders - he may become capricious, lethargic, or, conversely, act too excited. The skin becomes dry and pale, the child shudders, the extremities become cold, and the lips and nails acquire a bluish tint. This condition is fraught with quite serious complications: convulsions, delirium, hallucinations.

Causes of fever in children

Since an increase in body temperature is a kind of protective reaction of the body, there can be countless reasons for fever in children.

The most common culprits of this condition are viral and bacterial diseases. Please note that symptoms may vary depending on the infection. Also, the causes of fever in children can be various disorders of the endocrine system, tumors and even simple allergies.

Don’t forget: a child’s body’s thermoregulation mechanism is imperfect, so ordinary overheating can also lead to an increase in body temperature. If a toddler has been walking in the sun for a long time or a caring mother has wrapped him in “seven clothes and all with fasteners,” then it is quite predictable that after some time he may feel unwell and then develop a fever.

Treatment of fever in children

If we talk about the use of antipyretics, then this issue must be approached with the utmost caution. First of all, you need to take into account the extent to which the child feels unwell, what symptoms accompany the fever, and how serious its manifestations are.

If the baby has a fever, those around him must follow certain rules for caring for him:

• Be sure to provide your child with rest and bed rest;

• Under no circumstances should you try to persuade your baby to eat - eating only at will. Food should be easily digestible and liquid (various broths, purees, porridges and jelly). It is better to forget about fatty, spicy and fried foods;
• Drink as much warm water as possible. Try to give it in small portions, but often - the body needs to replenish the fluid lost through sweat, urine, and breath;
• While the temperature remains high, you cannot bathe the child. As a last resort, wipe it with a warm, damp towel;
• Monitor the thermometer in the room. If a baby is sick, the room should be about 25-26 °C; for older children, a temperature in the range of 22-23 °C is acceptable.

You can slightly reduce the fever without the use of medications using warm compresses on the forehead or general rubdowns. Cold should not be applied under any circumstances, as this can provoke vasospasm, and as a result, a deterioration in the child’s condition. Also, the recently popular method of wiping the skin with diluted alcohol or vinegar can also play a cruel joke. The fact is that, penetrating through the pores, such solutions can lead to poisoning of the body, and this will further aggravate the already sad situation.

Returning to the question of taking antipyretic drugs in the treatment of fever in children, it must be said that it is most advisable to prescribe them at a body temperature above 38 ° C. Do not forget to monitor the baby’s general condition: if the child’s health is worsening every minute, the child is pale and shivering, then the medicine must be given immediately.

Which method should you prefer? Naturally, as safe as possible. Modern pharmacology is replete with various medications specially designed for children and having antipyretic, anti-inflammatory and analgesic properties. Recently, doctors have abandoned the use of aspirin and analgin in pediatric practice, giving preference to drugs containing ibuprofen or paracetamol.

When giving any medications to a child, you must carefully follow the dosage according to age, and in no case increase it. If your baby has white fever, much less seizures, call an ambulance as soon as possible.

Text: Tatyana Okonevskaya

4.85 4.9 out of 5 (27 votes)

Fever is the body’s original protective reaction to the penetration of infection or viruses. It is accompanied by a restructuring of thermoregulatory processes, in other words, increased body temperature. As a result, the proliferation of most bacteria and harmful microscopic organisms is suppressed.

Causes of this condition

The most common causes of white or red fever:

• Infectious diseases in the acute period;
• Non-infectious diseases of an inflammatory nature;
• Dehydration, salt imbalance and other disorders of natural metabolism;
• Overheating;
• Endocrine system disorders;
• Allergies and the like.

Types of baby fever

More often than not, young children are diagnosed with red fever or, as it is commonly called, pink fever.

It is considered more favorable than white, and can be distinguished by the following signs:

• reddish and moist skin;
• a hot body, “bursting” with heat;
• warm extremities;
• increased heart rate and rapid breathing.

In this case, the child’s behavior remains unshakable, there is no room for seizures and other unpleasant phenomena. Antipyretics give rapid but short-lived results.

White fever that begins in a child is more dangerous, and its course is noticeably more severe for him. In fact, there is a large-scale overheating of all internal organs, including the brain.

Symptoms of the onset of white fever in a child are as follows:

• “Marbled” and unclear skin curtain, through which a bluish vascular network appears;
• Lips and nail beds also take on a bluish tint;
• Cold extremities;
• A “white spot sign” is observed when, after pressing on the skin, a white spot does not go away for a long time;
• The baby changes his behavior, becomes apathetic, lifeless and indifferent. He may experience convulsions accompanied by delirium.

Antipyretic medications do not give a full result, while antihistamines are completely prohibited.

Is it necessary to lower the temperature?

Having noticed the first signs of the disease, parents immediately begin to take out an antipyretic and vigorously stuff their child with it. But is this really necessary? Ideally, initially healthy children should not be given any medications until their body temperature exceeds 38.5°C.

Again, this statement may vary depending on the characteristics of each individual. For example, if a baby’s skin begins to turn pale, he is tormented by chills or muscle pain, and his overall condition becomes worse, then the temperature should be lowered urgently.

In situations where the child is at risk, and important complications arise against the background of fever, antipyretic treatment begins at 38.0 ° C (if we are talking about red fever), and at subfertile temperature (when white fever begins).

The risk of complications is present in children with chronic pathologies of the mental muscle and respiratory system, persistently impaired metabolism, and abnormal functioning of the central nervous system.

What to do with red hyperthermia?

Treatment of adults and children occurs according to the following algorithm:

• Cool and plentiful drinks with a slight antipyretic effect. These can be berry fruit drinks and compotes, rosehip decoction, lingonberry or cranberry juices, tea with lemon and more;
• If the skin is red, you should not wrap your child in rugs and blankets, even if he stings from the cold;
• The processes of evaporation and release of excess heat can be accelerated by wiping with vinegar diluted with water in a ratio of 3:1;
• Among the physical methods of cooling, it is recommended to apply a cloth napkin soaked in cold water to the forehead. It should be changed as often as possible. Bottles filled with cold water should be applied to the location of large vessels, that is, to the neck and groin area;
• If the temperature rises to 39°C, you can start giving an antipyretic, adhering to the age-specific dosage.

The absence of a visible reaction to all actions taken becomes a signal to call an ambulance. They are required to make a lytic mixture themselves, consisting of an antihistamine and an antipyretic drug. After such an injection, a strong increase in temperature is excluded.

What to do if you have hyperthermia?

Now let's figure out what needs to be done if white fever starts in an adult or a child:

• Warm drink in the form of herbal infusions, rosehip decoction or tea;
• White fever requires warming the limbs and rubbing each body until the skin turns pink;
• Classic folk methods also give their results. It is recommended to prepare a linden decoction, or a drink from warm water and raspberry jam.

In both cases, independently unresolved white and red (pink) fever requires the presence of physicians. In this situation, the lytic mixture they prepared will also contain an antispasmodic, one that will open the blood vessels and eliminate their spasm.

Other types of hyperthermia

A person can be diagnosed with more than one type of fever, although white and red are considered the most common.

Among the others it is worth highlighting:

• Rheumatic, surprising mental muscle of children whose age ranges from 3 to 5 years;
• Hemorrhagic, accompanied by toxicosis, weakness, internal and subcutaneous hemorrhages, general weakness and muscle pain; The main reasons for this condition are manifestations of the effects of the virus;
• Muscular, also of viral origin, and causing kidney failure. It is identified by bleeding from the nose and gums, chills, migraines, nausea and vomiting.

White fever in children and adults is not the worst thing. The situation is much more difficult with a high temperature that lasts for several weeks in a row and has an unknown origin. It is absolutely possible that the patient will have to undergo a comprehensive medical examination, pass all sorts of reviews and everything like that.

A high or high temperature is a signal that your child’s body is fighting an upcoming illness. Give him a chance to deal with it independently, but do not make the situation skeptical. Study all supportive measures, and do not rush into medications.

Pale fever in children is not a pleasant condition. The topic remains controversial and discussed to this day, especially with regard to children's health. With all the abundance of information and its accessibility to people, many still continue to zealously lower the temperature and nip the fever in the bud. There are differences between phenomena, and they have distinctive features, so you need to be able to interpret them correctly and make adequate decisions on the matter so as not to harm the baby. Not long ago we covered the topic and algorithm for helping in such a situation. This time we will touch on white fever in children, consider how it differs from pink fever, and how to properly provide assistance in such a situation.

White fever in children, also called pale fever, is an adaptive reaction of the body aimed at destroying invasive agents. Most often it can be found in respiratory diseases and viral infections. A febrile state in this case should be considered as a payment for stopping and suppressing the disease at its initial stage, and bringing down the temperature leads to reverse reactions and transfers the disease to a long-lasting and slowly flowing phase.

Symptoms of pale fever in children are quite detectable to the naked eye:

• elevated temperature, with its maximum values ​​noted on the torso and head, and the extremities remain cold
• chills may often occur
• the skin acquires a pale whitish tint and a network of blood vessels becomes visible on it
• the baby becomes lethargic and apathetic, refuses to eat and drink, does not play and is capricious.

The temperature spread can be quite large: 37-41 °C. At the same time, we cannot talk about critical and safe parameters; they simply do not exist. It is not always necessary to bring down high values, and not at all to the parameters of 36.6 ° C; a decrease of already 1-1.5 ° C gives the baby a significant relief of well-being. If we are talking about infants primarily under the age of one year, then values ​​around 38.5 °C can become hazardous to health; for older children we can talk about a threshold of 39.6 °C, although these are all rather arbitrary values ​​and cannot be tied to them, since .To. Each organism is individual. If the temperature values ​​have reached the given values, then you can think about reducing them.

Start with basic methods without resorting to drugs:

• Place a damp cloth on the forehead, wipe the neck and folds of the baby’s limbs with water. If your feet are cold, put on socks
• do not wrap your baby too tightly, this disrupts the exchange with the environment, reduces sweating and makes you feel even worse
• Give extra drink (fruit drink, compote).

If after several hours you have not noticed any positive trends in improving your child’s condition, and the temperature continues to rise, then it makes sense to take antipyretics according to the instructions. Paracetamol and ibuprofen are allowed here. These drugs act quite quickly, and after 40-60 minutes your baby should feel relief. If the situation does not return to normal, you observe the same signs, and the temperature continues to rise, you notice convulsions in the baby - call an ambulance and do not wait any longer, this can be fraught with serious complications. Pale fever in children It is more severe than red fever, and its symptoms are more painful and unpleasant, however, with the help offered correctly and in a timely manner, you can significantly reduce the risk of complications and stop the febrile state in 3-4 days. remember, that fever in children- This is not a disease, but a protective reaction of the body.

General diagnostic principles

emergency conditions in children

The need for productive contact with his parents or guardians to collect anamnesis and ensure a calm state of the child during examination.

The importance of getting answers to the following questions:

reason for seeking emergency medical care;

circumstances of illness or injury;

duration of the disease;

timing of deterioration of the child’s condition;

means and medications previously used before the arrival of the EMS doctor.

The need to completely undress the child at room temperature with good lighting.

Compliance with the rules of asepsis when examining a child with the obligatory use of a clean gown over uniform, a disposable surgical mask, especially when providing care to newborns.

Tactical actions of an EMS doctor

The decision to leave the child at home with the mandatory transfer of an active call to the clinic is made if:

the disease does not threaten the patient’s life and will not lead to disability;

the child’s condition has stabilized and remains satisfactory;

The child’s material and living conditions are satisfactory and he is guaranteed the necessary care that excludes a threat to his life.

The decision to hospitalize a child if:

• the nature and severity of the disease threatens the patient’s life and can lead to disability;

  unfavorable prognosis of the disease, unsatisfactory social environment and age characteristics of the patient suggest treatment only in a hospital setting;

Constant medical supervision of the patient is required.

Hospitalization of a child should only be accompanied by an emergency physician.

4. Actions in case of refusal of hospitalization:

if the treatment measures carried out by the EMS doctor are ineffective, and the child in a state of decompensation remains at home due to the parents or guardians’ refusal to hospitalize, then it is necessary to report this to the senior ODS doctor and act on his instructions;

any refusal to undergo examination, medical care, or hospitalization must be recorded in the EMS doctor’s call card and signed by the child’s parent or guardian;

if the patient or parent (or guardian) of the child does not want to formalize the refusal of hospitalization in the form prescribed by law, then it is necessary to attract at least two witnesses and record the refusal;

in case of refusal of hospitalization and the possibility of deterioration of the child’s condition, it is necessary to ensure the continuation of treatment at home with active dynamic visits to the child by a pediatrician at an outpatient clinic or an emergency physician.

Any forms of medical intervention require agreement with the child’s parents (guardians) based on the principle of informed voluntary consent in the framework of the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens, Articles 31, 32, 61.

Features of transporting children

Children who are conscious and in a state of moderate severity are transported with one accompanying person. Young children are held in arms or on laps. In case of pneumonia, bronchial asthma, stenosing laryngotracheitis, foreign bodies in the upper respiratory tract, after suffering from pulmonary edema, children are kept upright. In these cases, older children are transported on stretchers with a raised headboard. Children in extremely serious condition requiring resuscitation measures are transported separately from their parents.

In order to avoid the introduction of infection into a medical institution, the doctor, before bringing the child into the emergency department, must ask the medical staff of the hospital about the availability of quarantine for a particular infection.

Newborn babies, premature babies or those with any pathology are transported from the maternity hospital or from apartments in an ambulance by hand. The child must be wrapped in a warm blanket, covered with heating pads with a water temperature of 40-50 Cº (at the same time, there must be a sufficient layer of fabric between the heating pads and the child’s body), since these children, due to insufficient thermoregulation function, are especially sensitive to cooling. On the way, care must be taken to ensure that no aspiration of vomit occurs during regurgitation. To do this, hold the child half-turned in your arms, and during vomiting, transfer him to a vertical position. After vomiting, you need to clean the child's mouth using a rubber balloon.

Fever

Fever (febris, pyrexia) - This is a protective-adaptive reaction of the body that occurs in response to exposure to pathogenic stimuli, and is characterized by a restructuring of thermoregulation processes, leading to an increase in body temperature, stimulating the natural reactivity of the body.

Classification:

Depending on the degree of increase in axillary temperature:

Subfebrile 37.2-38.0 C.

Moderate febrile 38.1-39.0 C.

High febrile 39.1-40.1 C.

Excessive (hyperthermic) over 40.1 C.

Clinical options:

"Red" ("pink") fever.

"White" ("pale") fever.

Hypertensive syndrome .

Reducing body temperature is necessary in the following cases:

in children under 3 months. life at body temperature more than 38.0 o C;

in previously healthy children aged from 3 months to 6 years, with a body temperature of more than 39.0 o C;

in children with heart and lung diseases, potentially dangerous for the development of AHF and ARF, at a body temperature of more than 38.5 o C.

moderate febrile fever (more than 38.0 C) in children with convulsive syndrome (of any etiology), as well as in diseases of the central nervous system that are potentially dangerous for the development of this syndrome:

all cases of pale fever at a temperature of 38.0 C or more.

Pink fever- an increase in body temperature, when heat transfer corresponds to heat production, clinically this is manifested by the normal behavior and well-being of the child, pink or moderately hyperemic skin color, moist and warm to the touch, increased heart rate and respiration corresponds to an increase in temperature (for every degree above 37 C. shortness of breath increases by 4 breaths per minute, and tachycardia - by 20 beats per minute). This is a prognostically favorable variant of fever.

Pale fever- increase in body temperature, when heat transfer due to a significant impairment of peripheral circulation is inadequate to heat production, the fever takes on an inadequate course. Clinically, there is a disturbance in the condition and well-being of the child, persistent chills, pale skin, acrocyanosis, cold feet and palms, tachycardia, shortness of breath. These clinical manifestations indicate a pathological course of fever, are prognostically unfavorable and are a direct indication of the need for emergency care at the prehospital stage.

Hypertensive syndrome – an extremely serious condition caused by pale fever in combination with toxic damage to the central nervous system; clinic of pale fever with cerebral symptoms and varying degrees of impairment of consciousness.